کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5986376 | 1178843 | 2015 | 6 صفحه PDF | دانلود رایگان |
- Simple and reliable ECG markers for sudden cardiac arrest are needed.
- Discordant T waves in lead aVR are associated with lower ejection fraction, greater ventricular volume, higher BNP, and more denervated myocardium.
- Discordant T in lead aVR is an independent predictor of sudden death in ischemic cardiomyopathy.
BackgroundSimple and reliable ECG marker(s) for sudden cardiac arrest (SCA) could be very useful in assessing high-risk populations. Since ischemic repolarization abnormalities in the left ventricular (LV) apex are strongly correlated with discordant T waves in lead aVR, we sought to evaluate the clinical and prognostic significance of this feature in ischemic cardiomyopathy.MethodsThe PAREPET trial enrolled patients with ischemic cardiomyopathy eligible for a primary prevention implantable cardiac defibrillator (ICD). Those with persistent pacing or left bundle branch block were excluded. Amplitudes of T/aVR were automatically computed from median ECG beats at enrollment and endpoints were blindly adjudicated.ResultsThe sample was mainly composed of older men (n = 138, age 65 ± 12, 91% male, EF 29 ± 9%). At enrollment, amplitude of T/aVR significantly correlated with EF, indexed LV end-diastolic volume, B-type natriuretic peptide (BNP), regional scar volume, and PET-quantified denervated myocardium. After a median follow up of 4.2 years, there were 23 (17%) adjudicated SCA. In multivariate analysis, the presence of discordant T/aVR (> 0 mm, n = 42, 30%) was a significant and independent predictor of SCA (hazard ratio 2.0 [95% CI 1.0-4.9]) and cardiac death (hazard ratio 1.9 [95% CI 1.0-3.7]).ConclusionsIn subjects with ischemic cardiomyopathy, discordant T waves in lead aVR are associated with high-risk clinical parameters including lower ejection fraction, greater ventricular volume, higher BNP, and more denervated myocardium. Furthermore, discordant T/aVR remained an independent predictor of SCA and cardiovascular mortality even after accounting for these prognostic factors.
Journal: Journal of Electrocardiology - Volume 48, Issue 5, SeptemberâOctober 2015, Pages 887-892